Characterizing Arrests and Charges Among Individuals With Serious Mental Illnesses in Public-Sector Treatment Settings

At least five findings are noteworthy. First, 71% of a sample of patients recruited from three inpatient psychiatric facilities in Georgia had been previously arrested in Georgia, which means that the actual percentage would likely have been higher if the analysis had included data from other states. This high rate is consistent with prior literature involving individuals with serious mental illnesses (1, 15). Second, among those who had been arrested, the average number of lifetime arrests in Georgia was 8.6, and the average number of lifetime charges was 12.6. Third, among those ever arrested in Georgia, almost half (43%) had never been charged with a felony, and most of the charges were for misdemeanor or unclassified offenses. As policy change pertaining to criminal legal system reform (such as bail reform for misdemeanors) proceeds, the special needs of those with serious mental illnesses—who are at high risk of persistent inequities—must be intentionally and strategically addressed so that they can share equitably in the benefits of reform. Furthermore, racial inequities must be at the forefront of reform, not only with regard to the general population but also among those with serious mental illnesses.

Fourth, having lower educational attainment (<12 years), being female, being Black or African American, the presence of a co-occurring substance use disorder, and the presence of a mood disorder were associated with a greater number of arrests. The finding of more arrests among Black or African American participants was likely a reflection of the impact of structural racism across multiple systems (e.g., housing, employment, criminal justice [22], and health care), which contributes to the disproportionate arrests and incarceration of people of color, perhaps especially among those with serious mental illnesses. The lack of association between arrests and homelessness could be due to the fact that the sample was economically disadvantaged, and many participants who did not identify as homeless were nevertheless unstably housed (i.e., living with various friends or family members).

Fifth, the ranking of the most common charges varied substantially over time, from the earliest arrests that occurred at an average age of 20–21 years to the most recent arrests that occurred at an average age of 33–35 years. The earliest arrests commonly involved marijuana possession, driving under the influence, and shoplifting or burglary charges, whereas recent arrests more often included probation violations, officer obstruction–related charges, disorderly conduct, and failure to appear in court. (According to Georgia code, misdemeanor obstruction of an officer is defined as occurring when a person “knowingly and willfully obstructs or hinders any law enforcement officer in the lawful discharge of his official duties.” This, along with the misdemeanor “giving false name, address, or birthdate to an officer,” is, in essence, being uncooperative and getting in the way of the officer doing his or her job.) Some of this variation over 42 years (the arrest dates ranged from 1976 to 2018) is undoubtedly related to changes in policing and processing practices (e.g., less enforcement of marijuana possession). At the same time, future research should explore the extent to which the evolution of an individual’s criminal legal system history is related to the changes in the severity of his or her illness and to the psychosocial consequences of having a long-term serious mental illness. Just as Lorvick and colleagues (19) described how the “accumulation of criminal justice involvement” leads to a higher prevalence of unmet mental and physical health care needs, so too might the accumulation of adverse psychosocial consequences related to long-term serious mental illnesses lead to a change in the nature of arrest charges. That is, as more arrests and more charges accrue, the likelihood of failure to appear and probation violation increases, and such violations are also likely driven partly by the manifestations of long-term serious mental illnesses, including neurocognitive impairments and other symptoms, as well as lack of transportation and other social adversities. Having a long-term serious mental illness also appears to be associated with a higher likelihood of charges that may be illness related (e.g., disorderly conduct). Much more research is needed to understand the dynamic relationships between behavioral illness severity; socioeconomic disadvantage, including housing insecurity; and events leading to arrests (23).

Diverse policies, practices, and programs have been and continue to be developed to reduce criminal legal system entanglement among individuals with serious mental illnesses (24–27). Interventions benefit from targeting different points of the sequential intercept model (28): intercepts 1 (emergency services and law enforcement), 2 (booking, arraignment, and detention), 3 (jails and courts), 4 (reentry from jails or prisons to community), and 5 (probation and parole). Our findings may be informative. First, community-based mental health services (“intercept 0”) have a key role to play in reducing arrests and providing police with alternatives to arrest. New interventions and service models are needed that ensure appropriate interventions are available at the right time to mitigate the conditions or risk factors associated with police contacts and arrests (29). The findings reported here suggest that a potentially high-impact approach toward this goal would be for mental health professionals to ask regularly about clients’ legal involvement and work with clients on adherence to court mandates so that they do not experience the negative collateral consequences of failure to appear (30) and probation violations that can so easily result in additional arrests.

Second, we hypothesize that charges such as willful obstruction of officers and giving false name, address, or birth date to an officer (i.e., charges related to suboptimal interactions with the officer) may stem from prior negative experiences with the criminal legal system, including low perceived procedural justice (which concerns perceptions of neutrality, impartiality, or fairness; respect and dignity; having a voice; and trustworthy and transparent processes). Several North American studies examining experiences in police encounters (both crisis- and non–crisis-related) have indicated that individuals with serious mental illnesses feel very vulnerable when interacting with police officers and that how the officer treats them influences their feelings toward the encounter and their level of cooperation with the police (31–33). This is consistent with research originating in social psychology on policing and procedural justice: how people are treated by an authority in terms of fairness, dignity, and voice has implications for cooperation, perceptions of police legitimacy (34), and motivation to comply with the law (35). As such, new approaches need to be developed (for criminal legal system personnel) to improve empathy, fairness, dignity, and voice, which would improve perceived procedural justice and thus respect toward officers (which may ultimately reduce the likelihood of charges such as willful obstruction).

Third, because some charges (e.g., shoplifting and theft by taking) could stem in part from socioeconomic disadvantage and poverty—as opposed to the serious mental illness itself—progress in this area will remain limited as long as those with serious mental illnesses are disenfranchised. Many jurisdictions have been experimenting with public health–informed responses to people who engage in relatively minor criminal activities that may be a result of extremely adverse social conditions, recognizing that police may not be at all necessary in many of these situations and that other types of professionals may be better equipped to interact with vulnerable members of the community (36). Fourth, because some charges (e.g., disorderly conduct and “terroristic threats,” the latter including threatening “to commit any crime of violence”)—especially later in the course of serious mental illness—likely stem from illness manifestations, officers need more tools at their disposal to directly link symptomatic or behaviorally disturbed individuals to a receptive and accessible mental health system.

At least two methodological limitations must be acknowledged. First, although the study had the unique advantage of having highly objective data on lifetime arrests and charges, the RAP sheets captured only arrests occurring in the state of Georgia. As such, the figures presented here are undoubtedly underestimates of actual arrests. Furthermore, the RAP sheets we obtained had highly reliable information only on arrest history; conviction and sentencing history could not be relied on to be complete. Other research has documented inequities at later points in the criminal justice system. For example, Hall et al. (2) reported that a major mental illness diagnosis was associated with more than a 50% increase in the odds of a jail sentence for misdemeanor arrestees. Second, although internal validity was high, given the relatively homogeneous nature of the sample, generalizability might be limited because of the particular sociodemographic and clinical characteristics of the study sample (e.g., all participants were enrolled from public-sector inpatient settings, indicating a high level of socioeconomic disadvantage and clinical severity). Multisite studies, with larger and more representative samples, are warranted.

Given the substantial reforms that are under way, such as those in many police departments and in behavioral health crisis response systems across the United States, more fine-grained research on the exact charges experienced by people with serious mental illnesses over the life course is merited, as is more insight into the nature of the situations in which these charges are issued. Such findings, including those reported here, might point to both policy and programmatic solutions—within the criminal legal and mental health sectors—to reduce arrests and incarcerations in this population.

The authors gratefully acknowledge the support provided by Nora Haynes, M.Ed., Marsha O’Neal, Emile Risby, M.D., Mark Johnson, M.D., David Crews, and the patients, clinicians, and staff at Georgia Regional Hospital at Savannah, the Savannah Crisis Stabilization Unit at Coastal Harbor Health System, and the Gateway Crisis Stabilization Unit in Brunswick.